What are the differences between stroke comas caused by various types of strokes?
Coma is one of the main symptoms of stroke, but there are significant differences in the degree of coma between hemorrhagic and ischemic strokes. Patients with cerebral hemorrhage often experience coma, which is usually deep. When doctors press firmly on the patient’s eyebrows with their thumbs, the patients do not show any signs of pain, indicating a severe degree of coma.
Patients with cerebral thrombosis often show only dull consciousness without coma, presenting as sleepiness, able to respond to shouting, and then continuing to sleep. A few patients may exhibit mild coma, which is short-lived. Patients with cerebral embolism generally have clear consciousness and no coma, but a very few experience short-lived shallow coma. Subarachnoid hemorrhage often causes transient loss of consciousness.
How to distinguish stroke comas caused by intracerebral hemorrhage from other diseases?
Coma is a major feature of intracerebral hemorrhage, but it is also a symptom that may occur in many diseases. Therefore, it should be distinguished from diabetic coma, hypoglycemic coma, uremic coma, hepatic coma, encephalitis coma, and toxic coma caused by various reasons to avoid misdiagnosis and mistreatment. Given that patients are generally 50-60 years old, have a history of hypertension and arteriosclerosis, and suddenly develop coma, combined with symptoms such as hemiplegia, crooked mouth, incontinence, and unequal pupil size, intracerebral hemorrhage should be considered, and diagnosis is usually not difficult. Diabetic coma is caused by ketoacidosis in the late stage of diabetes, and patients have a long history of severe diabetes.
Urine sugar qualitative and ketone body positivity can be used for identification. Hypoglycemic coma is mainly caused by low blood sugar, with only mild coma and no other neurological symptoms such as hemiplegia and crooked mouth. After taking glucose, the coma can improve immediately, and identification is not difficult. Uremic coma generally does not have hemiplegia, and blood tests show increased urea nitrogen and creatinine, along with a history of chronic nephritis or pyelonephritis. Hepatic coma, encephalitis coma, and toxic coma are mainly identified based on medical history and laboratory diagnosis.
For example, patients with hepatic coma have a history of chronic hepatitis, and abnormal liver function, blood ammonia, and jaundice index are detected. Encephalitis coma has a specific incubation period and clinical manifestations such as fever and neck stiffness, and lumbar puncture for cerebrospinal fluid examination can confirm the diagnosis. Toxic coma has no neurological symptoms such as hemiplegia, and analysis of toxic substances in vomit and urine can make the distinction.
